Call Them Indispensable

We know how valuable doctors are. Each year, in our Top Docs issue, we provide the results of a national survey recognizing the best physicians in various fields.

But what about those women and men who are by our sides when we're sick or injured, awaiting surgery or recovering from it? These caregivers listen to our vital signs — and to our fears. They do all they can to ease our pain, increase our comfort, and calm our concerns. They get to know our family members as well as our medical history. They spring into action when a patient shows signs of failing. They weep when death wins, and rejoice when life prevails. They're nurses — and we could never do without them.

As a tribute to this profession, we asked representatives of six major hospitals to identify one nurse who reflects the qualities the hospital most values. Here, in a capsule, are their stories of dedication, determination, and joy in what they do.

Edith Brown

"Edith's consistency as a nurse, patient advocate, and educator make her an excellent representative for our nursing team."

At the age of 9, Edith Brown knew what she'd be when she grew up. Dazzled by a nurse who lived down the road in a rural part of Raleigh, Brown remembers the lady's "white uniform, white shoes, white cap" — and especially how she cared for neighbors in need.

One of nine children with "meager" but loving beginnings, Brown went on to receive her associate's degree in nursing from then-Memphis State University in May 1974. She was soon hired as a staff nurse at the old Baptist Memorial Hospital on Union Avenue and says she was "perfectly happy" serving her patients. But her supervisors saw management potential in the young woman, and from then on, "I had one opportunity after another."

In 1983 she became a unit manager overseeing 52 beds and 50 staff. While in that position, the hospital went through a redesign process and Brown's unit was dissolved. "It was a bittersweet time," she says. "I knew the changes would be for the better, but I also knew this process would literally change employees' lives. I tried to make it easier for them."

That redesign — one of many "life changers" for Brown — presented her with a new challenge. She moved into case management, where her role was to optimize the hospital experience for patients: "Whether they were insured, uninsured, or underinsured, I was their advocate. For those with a catastrophic illness, it was especially hard."

The year 2000 brought another "bittersweet" period for Brown, when BMH officials decided to close the Union Avenue location. "I had spent 26 years there and knew every nook and cranny," she says. Although it was a wrenching adjustment for her, she accepted a new challenge at what is now BMH-Memphis on Walnut Grove. Since then she has been in charge of staff development, educating and training nurses in the areas of medical/surgical, pulmonary, nephrology, pre- and post-op, and general skills.

Earlier this year, that training took on a super-tech edge when the hospital's Simulation Center opened. Using computerized mannequins to which the nurses give real names — including Phyllis, Hal, and Noelle — Brown and her colleagues can simulate most any human condition and treat it. Before, she recalls with a smile, "if we had one patient with a heart murmur, we'd have to go to that patient's room and ask, 'Can my student listen to your murmur?' The Simulation Center provides the repetition needed to hone nurses' skills."

In 1997, Brown learned what it was like to be a patient in her own hospital. While making the bed one morning, she experienced shortness of breath, and later while driving to work, intense chest pain. "I was 44 and this was totally unexpected," she says. As her husband rushed her to the ER, she prayed, "Dear Lord, it cannot end like this." Instead, the outcome was happy: She had a stent placed in her heart, and when that failed, she underwent bypass surgery. "I've been fine since."

Brown also knows what it's like to have a loved one with a terminal illness confined to the hospital. Her husband fought colon cancer, spending several weeks at Baptist. Although he died in October 2010, Brown's heartache has helped her grow. "I've learned that in my personal and work life, I have to be prepared for whatever walks through the door. I am what I am through the grace of God."

Her own experiences have enhanced her empathy for patients. "We don't know what situations or conditions our patients come from," says Brown, but she believes her passion for each one spills over to the staff. "We're very serious about providing the best care."

Michelle Mosby

"Michelle is known for her positive, uplifting spirit that she brings to work every day. And her experience in critical care is invaluable."

She knew she wanted to work with children. But when Michelle Mosby graduated from St. Joseph School of Nursing 33 years ago, she didn't know just how sick and vulnerable those children would be.

As a nurse in the intensive care unit of St. Jude since 1978, Mosby has cared for young cancer patients whose immune systems are weakened by chemotherapy and are at high risk for life-threatening infections. "Chemo is wonderful in its outcome," says Mosby, "but it's a rough road to travel. It's hard on many systems, but especially on the organs that work to excrete it. That's why we try to keep the liver and kidneys at their best state."

With eight nurses and eight ICU rooms, the ratio of nurse to patient is one-to-one. All nurses are specially trained in antibiotic and fluid therapy. "We have patients come in who are septic — that's when the body begins to shut down from chemo's side effects," Mosby explains. "We combat that with antibiotics tailored to specific germs. Some patients have bad organ damage from chemo. But children are remarkable. If we catch the problems early, the recovery can be soon."

She praises the teamwork that makes recovery possible. "It's a nurturing atmosphere, fostered by management. You know your job and you fill in where you need to fill in. There's no way any of us could do this alone."

She also praises St. Jude's infectious-disease doctors and says that, just as the cure rate for children's cancer has improved dramatically, so has survival from complications and infections. "We're also much better at educating the parents on what to watch for," she adds, "because nobody knows a child better than they do."

Naturally, she's come to know many children and families, some of whom stay for months. Each patient has different needs, and she learns how to respond to each. "We had a teenager with bone marrow transplants, and he got a bad fungal infection. He liked certain music and movies. He had a certain way he liked to be cleaned up. I learned not to take his blood pressure in his arm but in the leg — it gets uncomfortable in the same place so many times. With all patients, anything I do to make it bearable is what I strive for."

Early on she turned a listening ear to families. "Some people are more open than others, but after a while you get to know when something is bothering them. St. Jude is an amazing place, but being here is a strain on their lives, being separated from their usual support system. I like to think communicating with parents is something I do well. And I think I have a role in allaying fears."

Her colleagues agree, as Mosby recently received the Daisy Award for Extraordinary Nurses. She was nominated by a coworker for, among other compassionate acts, staying with a dying patient and his family through many grueling hours. "His parents knew it would happen, but not how," says Mosby, "and the process took much longer than expected. I think my being there made the parents a little more comfortable."

Many stories have happier endings, as years later parents and children return to visit the ICU team. "We had an infant who crashed twice on us," Mosby recalls. "We did CPR, and the baby pulled through both times. Her mother was given the odds, but she didn't like them and decided they didn't apply to her. It was endearing how she fought for her child's life." Today that child is 5 years old, and the mother is a nurse herself.

Throughout her career, Mosby says she's learned many life lessons. "I've learned to allow my faith to bring me peace. And it doesn't necessarily come from everything being 'fixed.' I do my best, then I leave it, and have faith that things will work out."

Sarah Thrush-Jonkus

"She has an incredible connection with her patients and is really a team builder. Her coworkers see her as the glue.

— Susan Law, Cardiology Nurse Manager, St. Francis Hospital-Memphis

An urge to travel led this young woman to teach English as a second language. But then she had a baby and learned what her true calling was. "The doctors were wonderful and I even considered being an obstetrician," says Sarah Thrush-Jonkus. "But it was the nurses who cared for me and encouraged me. And I thought, 'This is what I want to be — that person at the bedside.'"

While in nursing school at Union University-Germantown's accelerated program, having already earned her bachelor's in physics and math, Thrush-Jonkus went to work at St. Francis Hospital-Memphis as a nursing assistant. Though she'd been interested in OB/GYN nursing, "they hired me on the cardiac floor," she recalls, "and when I graduated I knew that's where I wanted to stay."

Describing how she feels about that awesome organ, the heart, the staff nurse offers this explanation: "It's complex and simple at the same time. I understand how the heart works and why and how certain things go wrong. Other systems are less definable, kinda fuzzy. But not the heart. It just makes sense to me."

Though she took up nursing, she didn't abandon teaching. Thrush-Jonkus is an instructor at Baptist College of Health Sciences. And at St. Francis, she teaches the Versant RN Residency program, which was developed by nurses, for nurses, to address the nursing shortage. Currently St. Francis is the only local hospital to offer this program. Thrush–Jonkus says it attracts nurses to the profession by offering more in-depth education. "Instead of just being thrown in, following a nurse for a couple of weeks, then suddenly being in charge of the patients, the Versant students get more extensive education on each system, a longer orientation, and training with nurses who have rising levels of experience."

Explaining her fondness for teaching, Thrush-Jonkus loves the light-bulb moments that all new nurses experience. "I watch them grow from not knowing anything, to seeing them understand the medications, to realizing what's going on with their patients — so at the end, they can put the pieces together, like a puzzle."

In addition to teaching, Thrush-Jonkus was also asked to serve on the hospital's Design Team of Shared Governance. "It's about nursing having more say in management with regards to how our practice is played out each day," she explains. Those involved discuss issues ranging from patient care to research to how to improve their jobs. They designed the bylaws for committees, and soon will be selecting nurse applicants to serve. "I'm excited about it," says Thrush-Jonkus. "I think it will be great for the nurses and especially the patients."

Like all nurses, she experiences her share of sadness. "So many of the patients are elderly. We see a lot of congestive heart failure. And when a patient goes downhill I'll think, 'Is there anything I could have done differently?' Even when you know there isn't, it's hard not to wonder."

But for the most part, she revels in her job. "I fell in love with the heart, the cardiac floor, the other nurses, the patients, the managers I've worked under. It's all been just right for me. And when you have a patient say, 'Oh, that really helped me,' — now that's rewarding."

Marcie Johnson

"I am touched by Marcie's ability to provide expert care and deep compassion to her patients and their families. She is truly an unsung hero."

Looking back on choosing a nursing career, Marcie Johnson credits her mother's nurturing example. "I'd see her care for her 14 children, then cook food for neighbors or help anybody in need. And I knew I wanted to give of myself, just as she did."

Johnson wound up giving back to her mother, who became afflicted with Parkinson's disease. "After I completed nursing school [at Southwest Tennessee Community College], she lived with me till the end," says Johnson. That caregiving experience, along with her own health struggles with asthma, have helped her empathize with patients' pain and tears. "I tell them, 'I know what you're going through. It's okay to cry.'"

Today, Johnson is nursing manager of the recently opened orthopedic unit at the Regional Medical Center. She started work at The Med 25 years ago as a clerk in radiology and later in medical records. But her 12 years in the trenches of the post- trauma unit of the Elvis Presley Trauma Center truly shaped her as a nurse: "It takes prayer to go in every day to see those patients. They've been stabbed, shot, had terrible injuries from vehicle accidents; some are paralyzed. You have to go in and lift them up."

Any given day can bring heartache or happiness. Johnson recalls a young man who suffered aortic injuries and bone fractures from a car collision. After a long hospital stay, the man was ecstatic to hear he'd soon be discharged. "But later that morning, his mother came to see him," says Johnson. "I'll never forget hearing her scream. The Code Blue team rushed to the room, and he was in full cardiac arrest. We worked and worked, but could not save him. You want to see tears? You'd have seen them that day — nurses, doctors, everybody." With trauma injuries, she explains, complications can occur with no warning. "You get up and walk and have a blood clot. No one's to blame."

Happy times help make up for the hard ones. One middle-aged patient was paralyzed from his waist down by a gunshot wound. The doctors and nurses pointed to test results, all showing that his spinal cord was severed, explaining why he'd never walk again. "But he didn't give up," says Johnson. "He told me many times that he would walk. And one day he came through that door, not on crutches or a walker — just on his own two feet."

Other patients have returned to show their appreciation for Johnson. Several have called her their angel. And Johnson believes in those mysterious beings. One night while lying in bed after a severe bout with asthma, she heard a woman's voice clearly saying, "Marcie, it's time to take your medicine." The voice spoke twice that night, and each time, says Johnson, "I floated above the bed with her and could see my shell just lying there." The inhalers that normally gave relief had failed her. But the next day — after receiving what she calls "spiritual medicine from my guardian angel" — the breathing mechanisms worked again. "Two doctors told me I should have been dead," she adds, "but I think the Lord spared me for a reason."

Managing the orthopedic unit, Johnson deals with staff concerns and operating room schedules. "This unit at The Med was developed so we could bring in some private-paying patients," she says, "so we need to be sure we have sufficient beds available for all of them."

But the best part of her work day is making rounds to see the patients. "I loved bedside nursing from the beginning," she says, "and I always will."

Cindy Reaves

"Cindy is a go-to person for so many areas of the O.R. and sets a powerful example for new or younger nurses."

Cindy Reaves gets personal when she cares for a patient. "I'm responsible for them from their head to their toes," she says, "and I'm going to treat them the way I would want to be treated."

As an operating room staff nurse at Methodist Le Bonheur Germantown for 21 years, Reaves compares herself in one way to a pilot before take-off — she checks and rechecks to ensure every safety measure has been taken. But her job goes further than that. "A lot of patient safety is technical," she explains, "and that can't take the place of the human touch." That's where comfort comes into play. Reaves listens to individuals, holds their hands, explains what to expect after surgery, and often prays with them beforehand. "I have the opportunity here to do that, and patients are very receptive to it," she says. "I don't push my beliefs on anyone. And I've found that people are usually comforted by a prayer."

Her patient advocacy extends to maintaining the person's dignity. "Some patients, women especially, are concerned about their dentures being removed. We can usually take care of that [in private]. Anything we can do that's safe for the patient but also good for their emotional well-being, we'll do it."

Her advocacy doesn't end when the patient is sedated. "I see to it that their body is covered when they're asleep, and that no people are present or activity taking place in the room that shouldn't be," says Reaves. "And I find out who they want to contact about their status, to give them updates, because the patient is not just one person but includes the family, the church family, the work family."

Reaves also tries to calm fears. "One of the biggest fears I hear from patients," she says, "is that they'll talk when they're under anesthesia and say something they shouldn't. They've seen some old TV show where a patient got a truth serum, and they're afraid they'll just blab everything." She gently sets their minds at rest: "They're not going to talk when they're asleep, and if they did, they won't say anything they wouldn't want us to know."

Reaves' path to the operating room started when she was 12, and her father had heart surgery. "I saw the good care he received and the impact that treatment had on our family," she says. As a teenager, she was a candy striper. "That was in the early 1970s, and I got to help bathe patients and take them to x-ray. I loved taking care of them." She graduated from Methodist School of Nursing in 1977 and later, after raising her children, took a refresher nursing course.

"Surgery has changed a lot since those early years," she says. "When I was a new nurse, a big incision was required to remove a gall bladder, and you'd be in the hospital 10 days." With the advent of laparoscopic and robotic surgeries, pain and length of hospital stays have decreased significantly. Still, she adds, "every surgery is major and you take nothing for granted. I tell the new nurses, 'You learn technology, but the patient is always your priority.'"

Over the years, Reaves has found joy in knowing patients' lives have been improved by surgery. And it really makes her day when a scenario like this takes place: "I might go to interview a patient and the person will say, "Oh, you took care of my son six months ago. I'm so glad you're my nurse!'"

She credits the doctors at Methodist Le Bonheur Germantown for their knowledge and the decisions they need to make. But she adds, "The nurses are the ones who see — or don't see — improvements and notify the physician. We're frontline, day in day out. It's a joy for me to come and do this work. It's a big part of who I am."

Sherry Ivy

"Diabetes is an illness that takes an entire family to manage. Sherry has embraced this concept and has made a difference in the lives of many children and families."

Working with adult patients at a hos-pital in Mississippi, Sherry Ivy saw diabetes rise at an alarming rate. Today, as a clinical nurse specialist at Le Bonheur Children's Hospital, she's on a mission to help its youngest victims.

Ivy — who received her nursing degree from Mississippi University for Women — educates parents and children about healthy eating habits, portion sizes, and weight control. "We have to get the parents to buy in," she explains. Some cope well, she adds, once they get over the shock. "I'd say they're grieving, because they've lost a sense of having a normal child," says Ivy. "And the child goes through that too. But if the parents are positive about the situation, so are the kids."

A big part of education, says Ivy, is dispelling myths about certain foods. One little girl said, "Miss Sherry, I can't have pizza anymore. I can't eat ice cream or candy." When Ivy explained that she could eat those foods in moderation, the girl's face lit up. "We explained about counting carbohydrates," says Ivy. "Once patients realize they can enjoy their favorite foods but in limited amounts, they accept it better."

Another challenge is teaching parents and children how to administer insulin. "Most parents have never given injections," says Ivy. "They think they'll give their child too much insulin. We teach them how to calculate the carbohydrates to determine the insulin dosage needed. Before they leave the hospital, we have them demonstrate this skill multiple times so the child will be safe at home. It's not easy, but the parents and kids work hard to master those skills. If they should give them too much — and that doesn't happen often — we have a 24-hour number they can call for help."

Also important for children and parents is being aware of low-blood-sugar symptoms. "One little girl gets real shaky," says Ivy. "A little boy says he gets nervous and has a headache. I tell them, 'That's your symptom. Remember it and be sure to tell your parents when it happens.'"

Ivy and other nurses also address weight control. "That can have a lot to do with Type 2 diabetes," she says, "but we don't make it the center of attention because the last thing we need is negatives." She also explains that some children with Type 1 diabetes — what used to be called juvenile diabetes — may be very thin. "That's because the glucose is staying in their blood and not being taken in by body cells. The parent will bring the child in saying, 'He's wasting away.'"

For some parents, fear and denial put their child at greater risk. Ivy recalls one mother who turned away at the sight of a needle. When her child was diagnosed with diabetes, she told Ivy, "I can't do this." But with Ivy's help, she conquered her fear. "She went from not bearing to look at a needle to giving her child multiple injections. It was a joyful moment for me when she said, 'I can take care of my baby.'"

Giving credit to nurses on her floor, she says, "They are the backbone of diabetes education. And the children are quick to pick up on what they're teaching. They'll say, 'Mom, I know what low sugar means.'" Learning those lessons now is vital to their future. "It empowers them to control their diabetes the rest of their lives and to minimize its serious complications."

"It's a responsibility and a joy," says Ivy, "thinking of the impact I can have on these children. I love what I do."